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. 1978 Jun 24;118(12):1533–1538.

Clinical pharmacology and therapeutics of benzodiazepines.

E M Sellers
PMCID: PMC1818113  PMID: 26460

Abstract

Benzodiazepines are among the most commonly prescribed drugs in the world. In contrast to their extensive use, the therapeutic indications and potential of benzodiazepines are limited. All benzodiazepine derivatives available in Canada are similar structurally and in their pharmacologic actions. Few have specific advantages over any others. For example, no benzodiazepine has been shown to be superior to chlordiazepoxide in the treatment of acute anxiety, chronic anxiety neurosis or insomnia. Barbiturates should not be prescribed for these problems since benzodiazepines are just as effective and are safer. Persons more than 70 years old should receive initial doses of benzodiazepines 50% less than those prescribed for younger persons, and individuals with cirrhosis should receive chlordiazepoxide or diazepam in one third the usual dose; oxazepam or lorazepam should be considered for these two groups of patients. Diazepam and chlordiazepoxide should not be given intramuscularly. Benzodiazepines should be prescribed only when clearly indicated and only for the necessary length of time.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Browne T. R., Penry J. K. Benzodiazepines in the treatment of epilepsy. A review. Epilepsia. 1973 Sep;14(3):277–310. doi: 10.1111/j.1528-1157.1973.tb03965.x. [DOI] [PubMed] [Google Scholar]
  2. Castleden C. M., George C. F., Marcer D., Hallett C. Increased sensitivity to nitrazepam in old age. Br Med J. 1977 Jan 1;1(6052):10–12. doi: 10.1136/bmj.1.6052.10. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Chaiton A., Spitzer W. O., Roberts R. S., Delmore T. Patterns of medical drug use - a community focus. Can Med Assoc J. 1976 Jan 10;114(1):33–37. [PMC free article] [PubMed] [Google Scholar]
  4. Cooperstock R. Psychotropic drug use among women. Can Med Assoc J. 1976 Oct 23;115(8):760–763. [PMC free article] [PubMed] [Google Scholar]
  5. Fejer D., Smart R. The use of psychoactive drugs by adults. Can Psychiatr Assoc J. 1973 Aug;18(4):313–320. doi: 10.1177/070674377301800410. [DOI] [PubMed] [Google Scholar]
  6. Giles H. G., MacLeod S. M., Wright J. R., Sellers E. M. Influence of age and previous use of diazepam dosage required for endoscopy. Can Med Assoc J. 1978 Mar 4;118(5):513–514. [PMC free article] [PubMed] [Google Scholar]
  7. Greenblatt D. J., Allen M. D., Noel B. J., Shader R. I. Acute overdosage with benzodiazepine derivatives. Clin Pharmacol Ther. 1977 Apr;21(4):497–514. doi: 10.1002/cpt1977214497. [DOI] [PubMed] [Google Scholar]
  8. Greenblatt D. J., Allen M. D., Shader R. I. Toxicity of high-dose flurazepam in the elderly. Clin Pharmacol Ther. 1977 Mar;21(3):355–361. doi: 10.1002/cpt1977213355. [DOI] [PubMed] [Google Scholar]
  9. Greenblatt D. J., Joyce T. H., Comer W. H., Knowles J. A., Shader R. I., Kyriakopoulos A. A., MacLaughlin D. S., Ruelius H. W. Clinical pharmacokinetics of lorazepam. II. Intramuscular injection. Clin Pharmacol Ther. 1977 Feb;21(2):222–230. doi: 10.1002/cpt1977212222. [DOI] [PubMed] [Google Scholar]
  10. Greenblatt D. J., Koch-Weser J. Adverse reactions to intravenous diazepam: a report from the Boston Collaborative Drug Surveillance Program. Am J Med Sci. 1973 Oct;266(4):261–266. [PubMed] [Google Scholar]
  11. Greenblatt D. J., Shader R. I., Koch-Weser J. Flurazepam hydrochloride, a benzodiazepine hypnotic. Ann Intern Med. 1975 Aug;83(2):237–241. doi: 10.7326/0003-4819-83-2-237. [DOI] [PubMed] [Google Scholar]
  12. HOLLISTER L. E., MOTZENBECKER F. P., DEGAN R. O. Withdrawal reactions from chlordiazepoxide ("Librium"). Psychopharmacologia. 1961 Feb 20;2:63–68. doi: 10.1007/BF00429621. [DOI] [PubMed] [Google Scholar]
  13. Klotz U., Antonin K. H., Bieck P. R. Comparison of the pharmacokinetics of diazepam after single and subchronic doses. Eur J Clin Pharmacol. 1976 Jun 15;10(2):121–126. doi: 10.1007/BF00609470. [DOI] [PubMed] [Google Scholar]
  14. Klotz U., Antonin K. H., Brügel H., Bieck P. R. Disposition of diazepam and its major metabolite desmethyldiazepam in patients with liver disease. Clin Pharmacol Ther. 1977 Apr;21(4):430–436. doi: 10.1002/cpt1977214430. [DOI] [PubMed] [Google Scholar]
  15. Klotz U., Avant G. R., Hoyumpa A., Schenker S., Wilkinson G. R. The effects of age and liver disease on the disposition and elimination of diazepam in adult man. J Clin Invest. 1975 Feb;55(2):347–359. doi: 10.1172/JCI107938. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Koch-Weser J., Sellers E. M. Drug therapy. Binding of drugs to serum albumin (second of two parts). N Engl J Med. 1976 Mar 4;294(10):526–531. doi: 10.1056/NEJM197603042941005. [DOI] [PubMed] [Google Scholar]
  17. MacLeod S. M., Giles H. G., Patzalek G., Thiessen J. J., Sellers E. M. Diazepam actions and plasma concentrations following ethanol ingestion. Eur J Clin Pharmacol. 1977;11(5):345–349. doi: 10.1007/BF00566531. [DOI] [PubMed] [Google Scholar]
  18. Preskorn S. H., Denner L. J. Benzodiazepines and withdrawal psychosis. Report of three cases. JAMA. 1977 Jan 3;237(1):36–38. [PubMed] [Google Scholar]
  19. Shull H. J., Wilkinson G. R., Johnson R., Schenker S. Normal disposition of oxazepam in acute viral hepatitis and cirrhosis. Ann Intern Med. 1976 Apr;84(4):420–425. doi: 10.7326/0003-4819-84-4-420. [DOI] [PubMed] [Google Scholar]
  20. Stanski D. R., Greenblatt D. J., Selwyn A., Shader R. I., Franke K., Koch-Weser J. Plasma and cerebrospinal fluid concentrations of chlordiazepoxide and its metabolites in surgical patients. Clin Pharmacol Ther. 1976 Nov;20(5):571–578. doi: 10.1002/cpt1976205571. [DOI] [PubMed] [Google Scholar]
  21. Thiessen J. J., Sellers E. M., Denbeigh P., Dolman L. Plasma protein binding of diazepam and tolbutamide in chronic alcoholics. J Clin Pharmacol. 1976 Jul;16(7):345–351. doi: 10.1002/j.1552-4604.1976.tb01531.x. [DOI] [PubMed] [Google Scholar]

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